Home Drug Guide Carphenazine Maleate

Drug Guide

Generic Name

Carphenazine Maleate

Brand Names Proketazine

Classification

Therapeutic: Antipsychotic/Antiemetic

Pharmacological: Phenothiazine derivative with dopamine antagonism

FDA Approved Indications

  • Psychotic disorders
  • Nausea and vomiting, especially in cases resistant to other treatments

Mechanism of Action

Carphenazine Maleate exerts its effects primarily by blocking dopamine receptors in the brain, which can help diminish psychotic symptoms and control nausea and vomiting.

Dosage and Administration

Adult: Dosage varies depending on condition; typically, 10-25 mg 2-3 times daily, titrated as needed.

Pediatric: Not commonly used in children; consult specific guidelines.

Geriatric: Start at lower doses due to increased sensitivity; close monitoring required.

Renal Impairment: Adjust dosage based on clinical response; no specific guidelines available.

Hepatic Impairment: Use with caution; dose adjustments may be necessary due to reduced metabolism.

Pharmacokinetics

Absorption: Well absorbed orally.

Distribution: Widely distributed in body tissues, including the brain.

Metabolism: Metabolized primarily in the liver.

Excretion: Excreted mainly in the urine.

Half Life: Approximately 8-12 hours, varies with individual metabolism.

Contraindications

  • Hypersensitivity to phenothiazines or other components.
  • Coma, CNS depression, or severe liver disease.

Precautions

  • Use with caution in elderly due to risk of extrapyramidal symptoms and anticholinergic effects.
  • Avoid in Parkinson’s disease due to dopamine blockade.
  • Monitor for neuroleptic malignant syndrome, tardive dyskinesia.

Adverse Reactions - Common

  • Sedation (Common)
  • Dry mouth (Common)
  • Hypotension (Common)

Adverse Reactions - Serious

  • Extrapyramidal symptoms (Less common but serious)
  • Neuroleptic malignant syndrome (Rare)
  • Dose-related tardive dyskinesia (Rare)

Drug-Drug Interactions

  • CNS depressants, other dopamine antagonists, anticholinergic drugs.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor mental status, neurological signs, blood pressure, and movement disorders.

Diagnoses:

  • Risk of falls due to sedation or hypotension.
  • Risk of movement disorders.

Implementation: Administer with food to decrease gastrointestinal upset; monitor for extrapyramidal symptoms; educate patient about potential side effects and safety precautions.

Evaluation: Assess effectiveness in controlling symptoms; observe for adverse reactions and adjust dosage accordingly.

Patient/Family Teaching

  • Do not operate heavy machinery until you know how this medication affects you.
  • Report any unusual movements, fever, or severe side effects immediately.
  • Avoid alcohol and other CNS depressants.
  • Take medication exactly as prescribed.

Special Considerations

Black Box Warnings:

  • Potentially fatal neuroleptic malignant syndrome.
  • Tardive dyskinesia may be irreversible.

Genetic Factors: No well-established genetic factors influencing response.

Lab Test Interference: Can cause false positives in certain urine drug screens.

Overdose Management

Signs/Symptoms: Excessive sedation, hypotension, extrapyramidal symptoms, seizures, coma.

Treatment: Supportive care, monitor vital signs, activated charcoal if ingestion was recent, manage symptoms symptomatically; no specific antidote.

Storage and Handling

Storage: Store at room temperature, away from light and moisture.

Stability: Stable under recommended storage conditions.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.